Cataracts

Most cataracts develop when aging or injury changes the tissue that makes up your eye’s lens.

Some cataracts are related to inherited genetic disorders that cause other health problems and increase your risk of cataracts. Cataracts can also be caused by other eye conditions, medical conditions such as diabetes, trauma or past eye surgery. Long-term use of steroid medications, too, can cause cataracts to develop.

How a cataract forms

The lens, where cataracts form, is positioned behind the colored part of your eye (iris). The lens focuses light that passes into your eye, producing clear, sharp images on the retina — the light-sensitive membrane on the back inside wall of your eyeball that functions like the film of a camera.

A cataract scatters the light as it passes through the lens, preventing a sharply defined image from reaching your retina. As a result, your vision becomes blurred.

As you age, the lenses in your eyes become less flexible, less transparent and thicker. Age-related changes cause tissues within the lens to break down and clump together, clouding small areas within the lens. As the cataract continues to develop, the clouding becomes denser and involves a greater part of the lens.

Cataracts may develop in only one eye, but they usually develop in both of your eyes. However, the cataracts usually aren’t totally symmetrical, and the cataract in one eye may be more advanced than the other.

Types of cataracts

Cataract types include:

• Cataracts that affect the center of the lens (nuclear cataracts). A nuclear cataract may at first cause you to become more nearsighted or even experience a temporary improvement in your reading vision. But with time, the lens gradually turns more densely yellow and further clouds your vision.

  As the cataract slowly progresses, the lens may even turn brown. Advanced yellowing or browning of the lens can lead to difficulty distinguishing between shades of color.

• Cataracts that affect the edges of the lens (cortical cataracts). A cortical cataract begins as whitish, wedge-shaped opacities or streaks on the outer edge of the lens cortex.

  As it slowly progresses, the streaks extend to the center and interfere with light passing through the center of the lens. People with cortical cataracts often experience problems with glare.

• Cataracts that affect the back of the lens (posterior subcapsular cataracts). A posterior subcapsular cataract starts as a small, opaque area that usually forms near the back of the lens, right in the path of light on its way to the retina.

  A posterior subcapsular cataract often interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night.

• Cataracts you’re born with (congenital cataracts). Some people are born with cataracts or develop them during childhood. Such cataracts may be the result of the mother having contracted an infection during pregnancy.

  These cataracts also may be due to certain conditions, such as myotonic dystrophy, galactosemia, Lowe’s syndrome or rubella. Congenital cataracts don’t always affect vision, but if they do they’re usually removed soon after detection.

Factors that increase your risk of cataracts include:

• Increasing age
• Diabetes
• Drinking excessive amounts of alcohol
• Excessive exposure to sunlight
• Exposure to ionizing radiation, such as that used in X-rays and cancer radiation therapy
• Family history of cataracts
• High blood pressure
• Obesity
• Previous eye injury or inflammation
• Previous eye surgery
• Prolonged use of corticosteroid medications
• Smoking

Make an appointment with your usual eye care provider if you notice changes in your vision. If your doctor determines that you have cataracts, then you may be referred to an eye specialist who can perform cataract surgery (ophthalmologist).

Because appointments can be brief, and because there’s often a lot to talk about, it’s a good idea to be well prepared for your appointment. Here’s some information to help you get ready and know what to expect from your doctor.

What you can do

• Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you’re taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For cataracts, some basic questions to ask include:

• Are cataracts causing my vision problems?
• What are other possible causes for my vision problems?
• What kinds of tests do I need?
• Do I need cataract surgery?
• Will cataract surgery correct my vision problems?
• What are the potential risks of cataract surgery?
• What will cataract surgery cost, and will my insurance cover it?
• Can I drive myself home after cataract surgery?
• How much time will I need to recover from cataract surgery?
• Will any usual activities be restricted after cataract surgery? For how long?
• After cataract surgery, how long should I wait before getting new glasses?
• If I use Medicare, will it cover the cost of cataract surgery? Does Medicare cover the cost of new glasses after surgery?
• How long can I take to decide about cataract surgery?
• Are there risks to delaying cataract surgery?
• If I wait a year or more before having surgery, will this make it more likely that surgery won’t restore my vision?
• If I don’t want surgery right now, what else can I do to cope with my vision changes?
• How will I know if my cataracts are getting worse?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions at any time that you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• Do you experience vision problems in bright light?
• How severe are your symptoms?
• Do your vision problems make it difficult for you to drive?
• Do your vision problems make it difficult to read?
• Do your vision problems make it difficult to do your job?
• Have you ever had eye surgery?
• Have you ever had an eye injury?
• Have you ever been diagnosed with an eye problem, such as inflammation of your iris (iritis)?
• Have you ever received radiation therapy to your head or neck?
• What medications are you currently taking?

To determine whether you have a cataract, your doctor will review your medical history and symptoms, and perform an eye examination. Your doctor may conduct several tests, including:

• Asking you to read an eye chart (visual acuity test). A visual acuity test uses an eye chart to measure how well you can read a series of letters. Your eyes are tested one at a time, while the other eye is covered.

  Using a chart or a viewing device with progressively smaller letters, your eye doctor determines if you have 20/20 vision or if your vision shows signs of impairment.

• Using a light and magnification to examine your eye (slit-lamp examination). A slit lamp allows your eye doctor to see the structures at the front of your eye under magnification.

  The microscope is called a slit lamp because it uses an intense line of light, a slit, to illuminate your cornea, iris, lens, and the space between your iris and cornea. The slit allows your doctor to view these structures in small sections, which makes it easier to detect any tiny abnormalities.

• Dilating your eyes (retinal examination). To prepare for a retinal examination, your eye doctor puts dilating drops in your eyes to open your pupils wide. This makes it easier to examine the back of your eyes (retina).

  Using a slit lamp or a special device called an ophthalmoscope, your eye doctor can examine your lens for signs of a cataract

The only effective treatment for cataracts is surgery.

When to consider cataract surgery

Talk with your eye doctor about whether surgery is right for you. Most eye doctors suggest considering cataract surgery when your cataracts begin to affect your quality of life or interfere with your ability to perform normal daily activities, such as reading or driving at night.

It’s up to you and your doctor to decide when cataract surgery is right for you. For most people, there is no rush to remove cataracts because they usually don’t harm the eye.

Delaying the procedure won’t make it more likely that you won’t recover your vision if you later decide to have cataract surgery. Take time to consider the benefits and risks of cataract surgery with your doctor.

If you choose not to undergo cataract surgery now, your eye doctor may recommend periodic follow-up exams to see if your cataracts are progressing. How often you’ll see your eye doctor depends on your situation.

What happens during cataract surgery

Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens. The artificial lens, called an intraocular lens, is positioned in the same place as your natural lens, and it remains a permanent part of your eye.

For some people, other eye problems prohibit the use of an artificial lens. In these situations, once the cataract is removed, vision may be corrected with eyeglasses or contact lenses.

Cataract surgery is generally done on an outpatient basis, which means you won’t need to stay in a hospital after the surgery.

During cataract surgery, your eye doctor uses local anesthesia to numb the area around your eye, but you usually stay awake during the procedure.

Cataract surgery is generally safe, but it carries a risk of infection and bleeding. Cataract surgery increases the risk of retinal detachment.

After the procedure, you’ll have some discomfort for a few days. You generally will be healed within eight weeks.

If you need cataract surgery in both eyes, your doctor will schedule surgery to remove the cataract in the second eye a month or two after the first surgery.